MS in the Workplace: An employer's guide - Multiple Sclerosis ...

MS in the Workplace:
An employer’s guide

MS in the Workplace: An employer’s guide
MS in the Workplace: An employer’s guide is a publication intended for
employers of those diagnosed with MS. It is a stand-alone piece which is
part of a resource for those affected by MS called, A Guide to Employment
and Income Support.
© MS Society of Canada, 2006, 2008. All rights reserved. None of the contents may
be reproduced in any form without prior written permission from the publisher.
Author: Avril Roberts
Editor: Nadia Pestrak
Further acknowledgements:
Thanks to Jennifer Carstens, Deanna Groetzinger, Teri Jiwa, Julie Katona,
Michelle Kristinson, Dr. William J. McIlroy, Diane Rivard, and Jon Temme
for their contributions.
Design: Greenwood Tamad Inc.
Printing:
ISBN: 0-921323-92-1
Multiple Sclerosis Society of Canada, 2008
Legal Deposit –
National Library of Canada

COVER ARTWORK
Kathy Harvey*
Dwelling Places, Oil on canvas
“I've had so many opportunities in my life to contribute.
I would never have dreamt that I'd be painting and
making money for the MS Society from it... if you don't
take opportunities – even ones you think you aren't capable
of – you miss out on a lot. Everybody, with MS or
otherwise, has something to offer. You just need to think
about what that is."
Kathy Harvey, who passed away in January, 2007, was an
artist and advocate for patient autonomy in long-term care
facilities. She began painting on a whim in the 1980s. Her
work raised over $200,000 for the Mississauga Chapter
through the sale of Christmas cards. She was a nationally
recognized mouth painter. Kathy received a number of
awards for her various contributions, including the MS
Society of Canada Sir David Flavelle Award of Distinction,
and the prestigious Ontario Medal for Good Citizenship in
2002. The Mississauga Chapter has created a volunteer
award in her honour, the Kathy Harvey Inspiration Award.
Christmas cards as well as limited edition prints of Dwelling
Places are available to be purchased through the
Mississauga Chapter at info.mississauga@mssociety.ca
*Assisted by Betty Williams

Table of Contents
MS in the Workplace: An employer’s guide
MS: an overview 4
MS and employment 8
Accommodation 10
Accommodation FAQ 18
Resources 20
www.mssociety.ca 3

MS in the Workplace:
An employer’s guide
This guide is designed to help you, as an employer, understand the nature of
MS and the types of issues that arise for people with MS in the workplace,
including disclosure of diagnosis, the employer’s duty to accommodate,
examples of accommodations for MS-specific symptoms, and strategies for
discussing and implementing workplace accommodation.
The goal is to provide you with sound information and resources that will help
you to retain your valuable employees with MS, keeping in mind that people
with MS now have a greater chance than ever of being employed for as long as
they are able, thanks to advances in the management of MS and in society’s
attitudes towards people with disabilities.
MS: an overview
What is MS
Multiple sclerosis is a chronic, non-contagious disease that affects the central
nervous system – brain, spinal cord and optic nerves. It is thought to be an
autoimmune illness in which the immune system mistakenly attacks the body. In
MS, the immune system attacks myelin, which is a fatty coating protecting the
nerve fibres of the central nervous system. Damage to any part of the myelin
coating or nerve fibre can disrupt messages moving through the central nervous
system. When these messages are distorted or blocked, a wide range of MSrelated
symptoms may occur.
MS symptoms
MS symptoms are unpredictable. They vary from person to person and also vary
in severity and duration. They may include:
visual disturbances
unusual and extreme fatigue
speech problems
changes in sensation, such as numbness or pain
loss of coordination or balance
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ladder and bowel problems
stiffness of muscles
weakening or paralysis of any part of the body
pain
mood or cognitive changes
Many people with MS are able to manage their symptoms and remain
productive in the workforce.
Course of MS
MS varies from person to person. Neither the person with MS nor a doctor can
accurately predict what course MS will take.
Types of MS
There are four main types of MS:
Relapsing Remitting
the most common form of MS (75% of cases at time of
diagnosis)
characterized by clearly-defined relapses (attacks) followed by
complete or partial recovery (remissions)
Secondary Progressive
about half of people with relapsing-remitting MS start to
worsen within 10 years of diagnosis, often with increasing
levels of disability and without remission
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Primary Progressive
a less common form of MS (10-15% of cases at time of
diagnosis)
people with this type of MS have a nearly continuous
worsening of symptoms from the beginning, usually without
clear relapses or remissions
Progressive Relapsing
relatively rare
combines relapses with steady worsening from the onset of the
disease
Relapse
In relapsing forms of MS, there is typically a period of acute symptoms (known
as an MS attack, relapse, exacerbation or flare-up), followed by a period of
partial or total recovery. A relapse can last from a day to weeks or months.
Many relapses are not severe and do not prevent people from business as usual,
though some may. Remissions (periods with little or no symptoms) can last for
weeks, months or even years.
Diagnosis
There is currently no one definitive diagnostic test for MS. Making the
diagnosis can take time because other diseases and medical conditions have to
be ruled out. Diagnostic tests may include MRI and/or CAT scans (which may
show any inflammation or damage to the myelin and nerve fibres); clinical
examinations; evoked potential tests ( which measure the speed at which
messages travel along nerve fibres in the brain) and spinal taps (which reveal
indications of an abnormal immune response).
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Treatment
MS can be treated in a variety of ways.
There are treatments that influence the underlying disease.
People on these disease-modifying therapies tend to
experience fewer and less severe attacks and show fewer areas
of brain damage (lesions) on MRI. These therapies are aimed at
slowing down or modifying the course of the disease and do
not necessarily improve current symptoms or prevent
pre-existing symptoms from recurring.
There are medications (steroids) that decrease the severity of
relapses when they occur.
There are many therapies that help ease several MS-related
symptoms.
As well, many people with MS benefit from non-drug
treatments and therapies such as rehabilitation, physiotherapy,
exercise, diet, stress management, psychotherapy,
complementary and alternative medicine.
Research
Researchers are working to develop better drugs and therapies to relieve MS
symptoms and stop the progress of MS. Extensive research is being done in
myelin regeneration, genetics, immune system, magnetic resonance imaging
(MRI) and the role of viruses. We don’t know what causes MS but researchers
are closer to finding the answer.
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MS is NOT
contagious
a mental disease
a fatal illness
Most people with MS can expect to live a normal or near-normal life span.
MS facts and statistics
Canadians have one of the highest rates of multiple sclerosis in
the world.
An estimated 55,000 – 75,000 Canadians have MS.
MS is the most common neurological disease affecting young
adults in Canada.
Women are three times as likely to develop MS as men.
MS and employment
Many people with MS continue working for many years after diagnosis and
retire at or close to the usual time. Others find that the variety, unpredictability
and severity of their MS symptoms interfere with their ability to continue in
their current jobs and change positions or even careers. Still others leave the
workforce much earlier than they intended. Of those who stop working, many
say they would have preferred to continue working and would have done so
with adjustments to their job tasks, work schedules or physical work
environment.
People with MS, like people with other chronic or disabling illnesses, sometimes
find that the greatest barrier in the workplace is their co-workers’ and
supervisors’ lack of understanding of their illness or disability and
misperceptions or reduced expectations about their skills and abilities.
Employees with MS develop strategies to manage their symptoms in the
workplace and look to their employers to promote workplace environments that
are supportive of all employees.
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Employers who exercise flexibility and creativity in retaining valuable employees
may find it more cost-effective than hiring and training new staff.
Points to keep in mind about MS:
MS is variable. No two people experience MS in exactly the
same way.
MS is unpredictable. Symptoms may come and go, stabilize or
improve. One set of symptoms may be replaced by another.
During periods of remission, it may seem as though the person
with MS has no illness at all.
Some MS symptoms are invisible. For example, a person with
MS may look fine but feel exhausted or be in pain. Invisible
symptoms such as extreme fatigue, pain or depression often
have the greatest impact on quality of life.
MS fatigue is different from ordinary fatigue. It is akin to
muscle weakness, physical tiredness and mental exhaustion
combined and can fluctuate on a day-to-day basis.
Changes in temperature, particularly hot weather, can trigger
or aggravate MS symptoms.
MS causes cognitive changes in some people, affecting their
short-term memory and concentration, or problem-solving
skills.
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Disclosure of diagnosis
An employee with MS does not have to disclose that he or she has MS. Some
people will choose to disclose their diagnosis, limitations or disability. Others will
not. The decision is personal.
Disclosure is legally required only if an employee is asking for job
accommodation. The employee is required to describe only the limitations in
carrying out the essential duties of the job and does not have to disclose the
diagnosis or nature of the illness.
The only questions an employer can legally ask an employee or interviewee
about an illness or disability are questions relating to the person’s ability to
perform the essential duties of the job.
When an employee decides to disclose the diagnosis to an employer,
confidentiality of medical information must be respected. The employer should
ask the employee how much information, if any, is to be shared with
supervisors and/or co-workers.
Accommodation
When MS affects job performance, an employee with MS has a right to request
accommodation. Accommodation is any change in the workplace environment
that enables a person with special needs to do a job. Small accommodations
can make a big difference to an employee’s effectiveness on the job and
improve employee morale. More than half of all job accommodations cost less
than $500. In some cases, the cost of accommodation may be partially
recovered through government programs, loans, grants, wage subsidies or tax
rebates.
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Types of accommodation
Modification of work schedule
flexible work hours, shift change, compressed work week
work on weekends, work from home
time off (without penalty) for medical reasons / appointments
Modification of job tasks
modification of the employee’s regular job
exchange of one type of job duty for another
reassignment of specific tasks to another position
job sharing
Modification of workstation / physical plant / building access
relocating a workstation closer to a washroom
raising a desk, widening a doorway, installing a ramp or
handrails
technical aids, special equipment and devices
wheelchair-accessible washrooms, designated parking space
Changes in workplace policies and procedures
Transfer to another position in the organization
Training for another position in the organization
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Examples of accommodations for
MS-specific symptoms
MS Symptom Sample Accommodation
Fatigue
Visual impairment
Temperature sensitivity
Gait and mobility
problems
Bladder and/or
bowel difficulties
Speech difficulties
Other
work from home
cot available for rest periods
flexible work hours
relocating a workstation closer
to a washroom
temporary reassignment of some work
responsibilities
altered lighting
adapted computer equipment
use of magnifiers
air conditioner, fan or heater, depending on
type of sensitivity
flexibility to work from home during hot
or cold spells
relocating a workstation closer to a
washroom
wheelchair access to workstations
cart for transporting supplies and
equipment
designated parking space
relocating a workstation closer to a
washroom
ability to work from home
adapted telephone and computer
equipment
job sharing
time off for medical appointments
unpaid leave
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Employer rights and responsibilities
Canadian employers (and unions) have a legal obligation to accommodate the
needs of employees (or union members) with disabilities, up to the point of
undue hardship. This obligation is known as the duty to accommodate. It is
set out in the federal Canadian Human Rights Act, Employment Equity Act and
provincial human rights legislation, and is reinforced in Supreme Court of
Canada rulings.
The duty to accommodate means that employers and/or unions must take
whatever measures are necessary to enable employees with disabilities to
perform their jobs to the best of their abilities. The duty to accommodate is not
open-ended, however. It may not be required, if an employer can show that
providing accommodation would cause undue hardship to the organization or
business.
Undue hardship is measured mainly in terms of health, safety and cost. That
means an employer would have to provide evidence that the proposed
accommodation would pose an undue risk to the health and safety of people in
the workplace. Or that the cost of the proposed accommodation is so high that
it would affect the very survival of the organization or business, or threaten to
change its essential nature.
Undue hardship may also take into account other factors, such as:
the type of work performed
the size of the workforce
the interchangeability of job duties
the financial ability to accommodate
the impact on a collective agreement*, and
impact on employee morale
*In some instances, the duty to accommodate can override a provision in a collective
agreement.
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Disability and the duty to accommodate
For the purposes of workplace accommodation, a disability is a physical or
mental condition that is both:
permanent, ongoing, episodic or of some persistence; and
a substantial or significant limit on a person’s ability to carry
out some of life’s important functions or activities, such as
employment.
Disabilities include both physical disabilities, such as mobility constraints; and
non-physical disabilities, such as cognitive dysfunction or mood disorders.
When approached with a request for accommodation, employers are
expected to:
determine what barriers might affect the employee
explore options for removing those barriers, and
accommodate to the point of undue hardship
Employers have a responsibility to obtain enough information to assess the
accommodation requirements. This may include asking the employee to provide
a medical report or undergo a medical assessment identifying the functional
limitations, suggesting types of accommodation that might be useful, and
indicating the prognosis – how long the employee is likely to need
accommodation.
Employers (and unions) have a responsibility to work with employees to
implement reasonable accommodation.
An employer does not have to provide accommodation if removing a
barrier or changing a workplace rule creates an undue hardship on the
business.
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An employer also does not have to provide accommodation if it can be
shown that a specific work rule, standard or practice, is based on a bona fide
occupational requirement (BFOR) or bona fide justification (BFJ). An example of
a BFOR would be, if an employee cannot meet a specific requirement of the
job; for example, the vision requirements for a position as an airline pilot or air
traffic controller.
If you are interested in knowing more about the steps an employer must take in
order to show a bona fide occupational requirement (BFOR) or bona fide
justification (BFJ) (the Meiorin and Grismer test), visit the Canadian Human
Rights Commission web site and look for the following document:
Bona Fide Occupational Requirements and Bona Fide Justifications under the
Canadian Human Rights Act: The Implications of Meiorin and Grismer
http://www.chrc-ccdp.ca/discrimination/occupational-en.asp.
Or contact the Canadian Human Rights Commission for a copy.
Canadian Human Rights Commission
(613) 995-1151
1-888-214-1090
Employee rights and responsibilities
Employees with disabilities have a right to ask for accommodation in the
workplace.
Employees are responsible for letting employers know that they need
accommodation and for suggesting, if possible, the type of accommodation
that would be appropriate. If an employee doesn’t let the employer know that
he or she needs accommodation, the employer may be absolved from the legal
duty to accommodate.
Employees are expected to provide employers with enough information to
determine suitable accommodation. For example, describing the effects the
disability has on their ability to perform their job and/or stating the specific
ways that a work rule, standard or practice adversely affects them.
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Employees are expected to cooperate with employers and/or unions in good
faith efforts to explore accommodation options and develop an accommodation
plan. This includes being flexible in considering the options and having realistic
expectations.
If an employer offers reasonable accommodation that enables an employee to
perform the essential duties of the job and the employee rejects it, the
employer may be absolved from the legal duty to accommodate.
Employees who think they have been refused accommodation or deliberately
discriminated against because of MS, have the right to make a formal complaint
to the appropriate human rights commission.
Employer/employee discussions
Discussions about workplace accommodation should begin with a situation
assessment:
What are the purposes and essential functions of the job?
How are the person’s limitations affecting the ability to
do the job?
What accommodations would be helpful?
Which accommodations would the employee prefer?
This information will form the basis for the development of an accommodation
plan.
10 strategies for discussing and implementing
workplace accommodation
Listen to what the employee says about the disability, the job
and what is needed.
Respect the employee’s desire for confidentiality and identify
specifically the form and degree of confidentiality.
Be open. Many adjustments cost little or nothing at all and
involve simple problem-solving and commonsense solutions.
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Be flexible and innovative in administering policies, procedures
and working conditions.
Be willing to explore creative solutions for job accommodation.
Seek advice from resources that specialize in job
accommodation, MS and disability issues. (See Resources.)
Be concrete and specific about what accommodations have
been identified. Also, what actions will be taken and indicate
who will do what by when.
Keep written records of key issues discussed.
Communicate with co-workers who will be affected by the
change proposed in the workplace.
Review periodically the effectiveness of the accommodations,
keeping in mind that needs may change.
Ways to value and support employees
with MS and other disabilities
Promote an organizational climate where everyone feels
included, valued and accepted.
Provide sensitivity training for co-workers about disabilities and
why people with disabilities need accommodation.
Dispel myths by educating staff about the causes, treatment,
and the personal experience of MS.
Educate managers about legislation so that they can have frank
discussions with employees about known disabilities and
desirable accommodations.
In company newsletters, include articles and information about
disabilities, including MS, and updates on research.
Sponsor fundraising initiatives for MS and other medical
conditions.
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Develop relationships with the MS Society of Canada and
organizations that specialize in MS and disability issues.
Contact community, government and corporate organizations
that provide expert advice, funding, equipment or support
services for workplace accommodation.
Accommodation – Frequently Asked Questions
What if you think an employee is unable to perform
essential job functions?
If you think that an employee cannot perform the essential duties of the job
because of disability, discuss the matter with the employee in a non-threatening
manner. Ask if there is any type of assistance that might enable the employee
to better perform his or her job functions. This may open the door to a
discussion of the employee’s functional abilities and limitations as they relate to
the essential job functions, a review of the job requirements, and an exploration
of accommodation options. You may find that the person can do the job with
reasonable accommodation.
What if you think an employee is abusing the right
to accommodation?
MS symptoms fluctuate. People with MS may not always need to use an
accommodation. Accommodation needs may also change. If you think an
employee is abusing the right to an accommodation, discuss the matter with
the employee and refer to the original agreements that were made. Both parties
should put key points in writing to help avoid misunderstanding.
What if an employee requests additional
accommodation?
As MS symptoms change, an employee’s need for accommodation may change.
Accommodations should be negotiated on a case-by-case basis.
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When can employment be terminated?
If the reason for termination is related to disability, accommodation must be
considered first.
Canadian employers (and unions) have a legal obligation to accommodate the
needs of employees (union members) with disabilities, up to the point of undue
hardship.
Termination of an employee with MS may be justified if an employer can prove
statistically and medically that the illness or disability makes the employee
incapable of safely and satisfactorily performing the job duties, even with
accommodation.
If the reason for termination is not related to disability, then terminating an
employee with MS is like terminating any other employee. The employer must
document in writing and discuss performance problems with the employee
before terminating the employee legally.
As an employer, if you are not sure about whether you have fulfilled the legal
duty to accommodate, you should contact the appropriate human rights
commission and seek legal counsel before making a decision to terminate.
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Resources
Current as of August, 2008.
Please be advised that resources
may change at any time.
Canadian Council on
Rehabilitation and Work
http://www.ccrw.org
Disability Awareness Series
Sensitivity training program
addressing disability issues in the
workplace.
Job Accommodation Service
Fee-based service for employers.
Canadian Human Rights
Commission
www.chrc-ccdp.ca
613-943-9146 1-888-214-1090
Bona Fide Occupational
Requirements and Bona Fide
Justifications under the
Canadian Human Rights Act:
The Implications of Meiorin
and Grismer
http://www.chrc-ccdp.ca/
discrimination/occupational-en.asp
Duty to Accommodate –
Frequently Asked Questions
www.chrc-ccdp.ca/preventing_
discrimination/toc_tdm-en.asp
Job Accommodation Network
http://janweb.icdi.wvu.edu
Job Accommodation Network
in Canada
1-800-526-2262
1-800-JAN-CANA
Free information and professional
advice to people with disabilities and
employers.
Human Resources and Social
Development
www.hrsdc.gc.ca
1-800-277-9914 – English
1-800-277-9915 – French
1-800-255-4786 – TTY
Opportunities Fund for Persons
with Disabilities
http://www.hrsdc.gc.ca/en/epb/sid/
cia/grants/of/desc_of.shtml
1-800-206-7218
Sphere-Quebec
www.sphere-qc.ca
514-904-2606 1-866-239-1177
Quebec contact for the Opportunities
Fund for Persons with Disabilities.
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How to reach the Multiple Sclerosis Society of Canada
NATIONAL OFFICE
175 Bloor St. East
Suite 700, North Tower
Toronto, Ontario
M4W 3R8
(416) 922-6065
ALBERTA DIVISION
#150, 9405 - 50 Street
Edmonton, Alberta
T6B 2T4
(780) 463-1190
ATLANTIC DIVISION
71 Ilsley Avenue, Unit 12
Dartmouth, Nova Scotia
B3B 1L5
(902) 468-8230
BRITISH COLUMBIA DIVISION
1501-4330 Kingsway
Burnaby, British Columbia
V5H 4G7
(604) 689-3144
Current as of August, 2008
Call toll-free in Canada: 1-800-268-7582
www.mssociety.ca
MANITOBA DIVISION
Suite 100, 1465 Buffalo Place
Winnipeg, Manitoba
R3T 1L8
(204) 943-9595
ONTARIO DIVISION
175 Bloor St. East,
Suite 700, North Tower
Toronto, Ontario
M4W 3R8
(416) 922-6065
QUEBEC DIVISION
550 Sherbrooke St West
Suite 1010, East Tower
Montreal, Quebec
H3A 1B9
(514) 849-7591
SASKATCHEWAN DIVISION
150 Albert Street
Regina, Saskatchewan
S4R 2N2
(306) 522-5600

Contact the
Multiple Sclerosis Society of Canada:
Toll-free in Canada: 1-800-268-7582
Email: info@mssociety.ca
Website: www.mssociety.ca
Our Mission
To be a leader in finding a cure for
multiple sclerosis and enabling people
affected by MS to enhance their quality of life.
C10E/08 Disponible en français.